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Different Approaches to Therapy

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There are many different theoretical approaches to, or perspectives on, the understanding and practice of counselling and psychotherapy. However, such diverse approaches actually have a lot more in common when it comes to actual practice than may appear at first sight.

Some of the fundamentals that are shared across the range of theoretical practices are: 

  • The importance of listening to, and understanding, the client’s experience.
     
  • The development of a positive working alliance between therapist and client.
     
  • The creation of a safe, secure and confidential space in which trust can develop and psychological work can be done.
     
  • The focus on the client’s needs and expectations.
     
  • The primacy of the client’s well-being.
     
  • The use of the relationship between therapist and client to promote a deeper understanding of the client’s experience. 

What follows is an explanation of the four major strands of counselling and psychotherapy practices in Ireland today. It is taken from The Irish Council for Psychotherapy (ICP) “Guide to Psychotherapy in Ireland”.

 

COGNITIVE BEHAVIOURAL PSYCHOTHERAPY (CBT)

The philosophical underpinning of this approach is that a person learns to act and think in certain ways as a result of their experiences and their perceptions of those experiences. This learning is a life-long process. Usually what we learn is adaptive and functional – we learn to become active participants in our lives, our society and our culture. However, occasionally we learn ways of thinking, feeling or behaving which hinder us in our development and prevent us from achieving our potential. Sometimes a single event such as being bitten by a dog, or a car crash, will have major repercussions or more often, experiences which go over a longer period of time eg being bullied or being unemployed can affect us emotionally in the long term. Such negative experiences and responses to them can lead us to develop low self-esteem, unhappiness, bitterness, anxiety, passivity, aggression, perfectionism and so on. These, in turn, colour the way we perceive new experiences and at worst, if unchecked , can lead to such disorders as clinical depression, eating disorders, obsessive-compulsive disorder and panic disorder.

Whereas in the past, Behaviour Therapy dealt only with what was observable, ie actions and behaviours, assuming rightly that once these were changed, thoughts and feelings would change to match the new behaviours. The cognitive therapists postulated that people can achieve change by working directly on their own patterns of thinking. Just as we may have, through our life experiences, learned distorted patterns of thought (patterns which hinder rather than help), so too can we learn new, helpful and functional thought patterns. The way we think impacts on every aspect of our lives, from hopefulness regarding the future, to personal relationships, to how we see ourselves and everything in between.

Cognitive and behavioural interventions overlap in their shared purpose of loosening the hold a particular negative belief has on the client and engaging him/her in a re-evaluation of his/her perceptions and assumptions.

The progress of the therapy is interactive. Its axis is in a relationship between the client and the therapist. The therapist uses a systematic framework that recognises the client as an individual and his/her need to be a participant in the solution to their own problems. The key characteristics of the cognitive behavioural approach are: 

  • Assessment/analysis of the problem
  • Creating a therapeutic alliance
  • Agreed therapy goals and targets
  • Regular measurement and evaluation of progress towards targets 

Assessment is individual for each client. It involves detailed questioning to enable the client and therapist to define accurately the problem and set the goals of treatment. Cognitive behavioural psychotherapy concentrates on the present – how we are now. It is practical and pragmatic, a collaborative effort by the therapist and client working together, rather like an investigative team, and is based on sound research findings. The aim of therapy is to provide the client with the knowledge and techniques which he/she can use now and in the future, in effect, making the therapist redundant. Therapy is time-limited and can be individual, family or group. Group treatments include  Assertiveness, Stress Management, Anger Management and Social Skills Training. Each client is given a detailed account of treatment options and their consent is sought before embarking on therapy. Registered practitioners adhere to a code of ethics, and are committed to research and the development of theory within this sphere. 

 

SYSTEMIC FAMILY THERAPY 

Systemic Family Therapy incorporates individual, couple and family therapy. 

What is special about Family Therapy? 

Family Therapy is the most popularly recognised descriptive title for a body of practice and theory which continues to evolve and to grow at an extraordinary rate. Originally, the approach was distinguished by the practice of including entire families in the therapy process rather than an individual client. This practice continues, but is not a necessary aspect of the approach. The principle which informed Family Therapy from the time of its inception in the 1950s has been to transcend simple cause and effect explanations which located deficits within the individual, and to include those aspects of the client’s context in the therapy process which will enable them to manage, resolve or better understand their difficulty. It is this ecological view which attends to the interconnectedness of people, of beliefs and of all things, which characterises Family Therapy rather than the number of people sitting in the therapy room. 

How do Family Therapists view problems and reality?  

Many Family Therapists seek to engage the clients in a collaborative exploration of their presenting dilemma, focusing on the beliefs, and the interactions which maintain the difficulty or which prevent its resolution. By better understanding the interconnectedness of the biological, the social and the psychological dimensions of the problem, choices are introduced, conflicts are transcended and new patterns of understanding are generated. 

A significant part of each one’s experience is the beliefs, the language, the stories and values which constitute our life experience. We are not only born into a material and physical reality, but also into a multi-layered complex weave of beliefs and behaviours, which for most of us are, initially at least, of a family nature. This strongly influences our developing “reality”. We are born into the world totally dependent on one or more caring adults, and if the constitutional and contextual aspects of our lives are supportive enough, we learn to operate more independently and to exercise choice in our lives more effectively. This requires an appreciation of the interdependence of our lives, of the world in which we live, and the limits and possibilities which it contains. We constantly explore the limits and possibilities of relying on previous learning and exploring new ways and new beliefs. We may be strongly influenced to find ways of being which contrast with some of our significant life experiences, or we may repeat our experiences, often with the assumption that this is how the world is, and how everyone should be. 

When two or more people live in close proximity, we can expect that differences, and inevitably conflicts, will ensue. This is part of the rich weave of our lives which continue to challenge us and to teach us. 

Sometimes, our adult lives may be thrown into inner turmoil, we may experience self-doubts, destructive feelings or immobilising depression or anxiety. These disturbing experiences may be triggered by what would be relatively small or manageable difficulties for others, and even for ourselves in somewhat different circumstances. Such problems are frequently related to early life and usually early family aspects of our lives. Our difficulty trusting others, exercising choice or living with an adequate level of autonomy may be related to not having had sufficiently secure, loving or affirming experiences in our early family relationships. More recent traumas, abuse, oppression or unresolved conflict may also contribute to distressing inner feelings, which can be successfully resolved in Family Therapy. 

What do Family Therapists do? 

Family Therapists universally employ the most inclusive frame to help clients made sense of their doubts or confusion.

Some Family Therapists put most emphasis on exploring the beliefs, some the language and stories and some the repeating behaviour patterns. They may also elect to examine the attempted solutions or to focus attention on experiences which work well for the client, their successful solutions. 

How many attend Family Therapy together? 

The extent to which Family Therapists will emphasise the inclusion of others in the process may vary. With relationship problems, we usually prefer to include the main participants. It is not uncommon for parents to successfully attend a series of consultations regarding one of their children, without the child being present. Extended family members may be invited or partners or others who are significantly involved in the client’s life and difficulty. It is also common for individuals to attend alone, when the focus will include the significant relationships of their lives as the context of their emotional and psychological realities. Agreeing who will attend is usually an integral part of the exploratory process. 

 

HUMANISTIC AND INTEGRATIVE PSYCHOTHERAPY 

Psychotherapists from a Humanistic and Integrative perspective invite people to develop their awareness as to what prevents them from unfolding their own true nature in the inner and outer expressions of their life. 

The Nature of Humanistic and Integrative Psychotherapy: 

Within the Humanistic and Integrative approach, some commonly held assumptions about the human person are as follows: 

  • The individual is seen as a whole person living out their present level of integration through their body, feelings, mind and psyche.
     
  • People have responsibility for their lives and for the choices they make. People are responsible not only for their actions but their failure to act.
     
  • Humanistic and Integrative psychotherapy is based on a phenomenological view of reality. Its emphasis is on experience. Therapists within this perspective frequently engage active techniques to encourage a deepening of the therapeutic process. There is a movement away from the goal of understanding events towards the active exploration of experience.
     
  • The nature of the person is seen as dynamic. The person is seen as unfolding in different stages. There is always a thrust towards wholeness and life, but sometimes along the way, at any one stage, an overwhelming failure or frustration can be experienced as anxiety, depression or even a vague sense of an unlived life. These experiences can impede the emergence of alter stages or result in an uneven integration as the person develops.  

The Nature of the Therapeutic Process: 

Humanistic and Integrative psychotherapies have many broad and creative approaches to working with clients. The therapeutic relationship is seen as a meaningful contract between equals, and the aims of therapy may include encouraging the self-healing capacities of the client, exploring the client’s concrete individual experience of anxiety and distress rooted in earlier relationships, enabling insight into repeating patterns of behaviour which might be preventing clients from leading fulfilling and satisfying lives.

The attitude and presence of the psychotherapist is important. Irving Yalom speaks about the therapist entering into the client’s experiential world and listening to the phenomena of that world without the pre-suppositions that distort understanding. Carl Rogers focused on the importance of deep, attentive listening on the part of the psychotherapist in promoting change. 

The Integrative Perspective: 

Practitioners in this field embrace an attitude towards the practice of psychotherapy that affirms the inherent value of each individual. It is a unifying psychotherapy that responds appropriately and effectively to the person at the emotional, behavioural, cognitive and physiological levels of functioning. The aim of integrative psychotherapy is to facilitate wholeness so that the quality of the person’s being and functioning in life is maximised with due regard for each individual’s own personal limited and external constraints.

 

PSYCHOANALYTIC PSYCHOTHERAPY 

Psychoanalytic psychotherapy is a process which takes place in a relationship between psychotherapist and client who work together to explore the client’s distress and difficulties. The psychoanalytic approach is based on the understanding that memories and feelings that were too painful or disturbing for the person to bear were repressed in the unconscious where they continue to exert a powerful, but hidden, influence on the individual’s life. We may become aware of this phenomenon in our lives when, to our dismay, we discover that we have been repeating over and over again, patterns of relationships or life choices that we belatedly recognise were destined to bring us pain from the outset.

The psychoanalytic process opens up an ongoing revelation of our hidden selves. In practice, it takes the form of the client talking, encouraged by the psychotherapist to say whatever comes to mind. As the therapy proceeds, this experience of freedom to speak leads to increased spontaneity and ease in the client who becomes more able to acknowledge and express feelings and thoughts that had been deeply buried and link these to current experiences.

Through such detailed exploration of below-the-surface content eg working with dreams, the client is enabled to develop a further understanding of the complexity and richness of psychological experience and thereby become much greater in charge of his/her own life.